KRIM-KONGO-HÄMMORHAGISCHES FIEBER - TÜRKEI ( 06 )
*********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sat 14 Jun 2008
Source: Today's Zaman [edited]
<http://www.todayszaman.com/tz-web/detay ... &bolum=101>


Medical tests have confirmed that 2 physicians are infected with
Crimean-Congo hemorrhagic fever (CCHF), a disease carried by certain tick
species. The chief physician of Ankara Numune Hospital, where the 2 doctors
had treated a patient with complaints of a tick bite, verified yesterday
[13 Jun 2008] that the doctors have the disease after results came in from
blood samples. The disease is also known to be transmitted through direct
contact with the blood or secretions of an infected person. The doctors
were most likely infected by direct contact with the patient's blood when
it splashed into the doctors' eyes as they tried to stop the bleeding of
the patient's nose.

Blood samples have also been taken from a nurse and other health personnel
at the hospital and sent to the Refik Saydam Health Center for analysis.
The results will show whether or not the nurse and the other personnel have
CCHF, which has recently sparked fears throughout the country. The doctors
are already displaying symptoms of CCHF. Health staff said currently about
20 people suspected of having CCHF are under observation at Ankara Numune
Hospital.

Meanwhile, another person in the central Anatolian province of Yozgat died
of CCHF. After being bitten by a tick, a resident of the village of
Karakaya had 1st been seen at the city hospital and then was transferred to
Erciyes University Medical Faculty Hospital. The death toll from CCHF in
Yozgat is now 3 following the death of this patient. This year [2008], 500
people in the province [have sought treatment] at area hospitals with
complaints of tick bites. More than 20 people from throughout central
Anatolia have died this year from CCHF.

In addition, a woman from Bursa reportedly has CCHF. The 45 year old woman
was working in the field when she was bitten by a tick. She did not seek
treatment for the bite because the tick was not stuck to her skin. After
being hospitalized with vaginal bleeding twice following the bite, she was
placed in intensive care and diagnosed with CCHF.

Another woman, a resident of Manisa, sought treatment for a tick bite at a
hospital. The tick was removed by doctors from Kirkagac State Hospital.

Experts say people who have come into contact with a tick should be
monitored for 10 days following contact and seek professional medical care
if symptoms of fever, headache, nausea, vomiting or diarrhea present
themselves. Treatment for CCHF is primarily symptomatic and supportive, as
there is no established course of treatment.

--
communicated by:
Claudio Po
<ClPo@regione.emilia-romagna.it>

[The risk of contracting CCHF in the central Anatolia region of Turkey
remains undiminished despite the increasing awareness of the problem. A map
of the provinces of Turkey is available at
<http://www.mapsofworld.com/turkey/turke ... l-map.html>. Kirkaga and
Yozgat are adjacent provinces in the centre of Turkey. Bursa is in the west.

Unfortunately, hospital-acquired infections are not unknown [see, for
example, Mardani M, Rahnavardi M, Rajaeinejad M, Naini KH, Chinikar S,
Pourmalek F, et al. Crimean-Congo hemorrhagic fever among health care
workers in Iran: a seroprevalence study in two endemic regions. Am J Trop
Med Hyg. 2007 Mar;76(3):443-5.
<http://www.ncbi.nlm.nih.gov/pubmed/1736 ... d_RVDocSum>.
- Mod.SH] and are one of the hazards associated with treatment of advanced
CCHF. - Mod.CP]

KRIM-KONGO-HÄMMORHAGISCHES FIEBER - TÜRKEI (07)
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 16 Jun 2008
Source: Today's Zaman online [edited]
<http://www.todayszaman.com/tz-web/detay ... k=14496601>

Two physicians and an assistant paramedic at the Diyarbakir Dicle
University School of Medicine Research Hospital were quarantined on
Sunday [15 Jun 2008] for probable contraction of Crimean-Congo
hemorrhagic fever (CCHF), a disease carried by certain tick species
[classified in the genus _Hyalomma_].

The university said the 3 were quarantined as a precaution after
treating a CCHF patient who later died at the hospital. The
quarantine follows an official announcement last week from Ankara
Numune Hospital saying that 2 of its doctors who had treated a CCHF
patient had contracted the infection [see: Crimean-Congo hem. fever -
Turkey (06) 20080615.1888].

The disease can be transmitted through direct contact with the blood
or secretions of an infected person. The doctors were most likely
infected by direct contact with the patient's blood when it splashed
into their eyes as they tried to stop the patient's nose from
bleeding, the Ankara hospital said. The doctors were already
displaying symptoms of the disease. The hospital's health staff said
on Friday [13 Jun 2008] about 20 people suspected of having
contracted CCHF were under observation at the hospital.

Last Friday, news reports said yet another patient had died of CCHF
in the central Anatolian province of Yozgat. So far, 500 people in
the province have visited area hospitals this year [2008] complaining
of tick bites.

Since 1st observed in Turkey in 2002, 114 people have died of CCHF in
the country, including 22 so far this year [2008]. The fever is
particularly common in the central Anatolian and eastern Anatolian
provinces, especially Tokat, Corum, Sivas, Amasya, Yozgat, Gumushane,
Bayburt, Erzurum and Erzincan. Last year [2007], 717 people were
diagnosed with the disease, claiming 33 lives.

Experts say people who have come into contact with a tick should be
monitored for 10 days following contact and seek professional medical
care if symptoms of fever, headache, nausea, vomiting or diarrhea
present themselves.

--
Communicated by:
ProMED-mail Rapporteur A-Lan Banks

[This is the 2nd report from Turkey in the past few days of suspected
or confirmed diagnosis of CCHF in healthcare workers. Healthcare
workers in CCHF endemic areas should be aware of the illness and the
correct infection control procedures to protect themselves and their
patients from the risk of nosocomial infection.

WHO advises that healthcare workers in endemic areas should adopt
correct infection control procedures to protect themselves and their
patients from the risk of nosocomial infection. Healthcare workers
are at risk of acquiring infection from sharps, injuries during
surgical procedures and, in the past, infection has been transmitted
to surgeons operating on patients to determine the cause of the
abdominal symptoms in the early stages of (at that moment
undiagnosed) infection. Healthcare workers who have had contact with
tissue or blood from patients with suspected or confirmed CCHF should
be followed up with daily temperature and symptom monitoring for at
least 14 days after the putative exposure. When patients with CCHF
are admitted to hospital, there is a risk of nosocomial spread of
infection. In the past, serious outbreaks have occurred in this way,
and it is imperative that adequate infection control measures be
observed to prevent this disastrous outcome.

WHO advises also that patients with suspected or confirmed CCHF
should be isolated and cared for using barrier nursing techniques.
Specimens of blood or tissues taken for diagnostic purposes should be
collected and handled using universal precautions. Sharps (needles
and other penetrating surgical instruments) and body wastes should be
safely disposed of using appropriate decontamination procedures.

The prevalence of CCHF is more or less coincident with the
distribution of _Hyalomma_ spp. ticks, the vector of the disease. A
map of the geographic distribution of CCHF can be found at:
<http://www.who.int/csr/disease/crimean_congoHF/en/>,
and illustrations of _Hyalomma_ spp. ticks can be seen at:
<http://www.123rf.com/stock-photo/hyalomma.html>.

A map of the provinces of Turkey is available at:
<http://www.mapsofworld.com/turkey/turke ... l-map.html>.
- Mod.CP]

KRIM-KONGO-HÄMMORHAGISCHES FIEBER - TÜRKEI ( 08 )
*********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] Turkey - 4 more deaths
[2] Vector abundance

******
[1] Turkey - 4 more deaths
Date: Thu 19 Jun 2008
Source: Today's Zaman online [edited]
<http://www.todayszaman.com/tz-web/detay ... &bolum=101>


Tick-borne disease claims 4 lives in 2 days
-------------------------------------------
Despite the warnings of officials and measures taken to prevent the
spread of Crimean-Congo hemorrhagic fever (CCHF), which is
transmitted by tick bites and can be fatal, the disease continues to
claim lives -- killing 4 people in Turkey in the last 2 days.

A 53-year-old woman who was transferred to the Izmir Ataturk Research
Hospital from her home town of Canakkale with a suspected case of
CCHF died on Tuesday [17 Jun 2008].

Meanwhile a mother of 2 and a farmer in a village in Ayvacik
district, was bitten by a tick 3 weeks ago. She reportedly tried to
pull the tick off her skin on her own and soon started having
terrible abdomen aches. She turned to the Ayvacik State Hospital and
was then transferred to Izmir 2 days ago for more treatment. She also
died on Tuesday.

Another woman receiving treatment for CCHF in Sivas also died. The
woman, 84, was taken to Cumhuriyet University's School of Medicine
Hospital 4 days ago after being bitten by a tick. Her condition
rapidly deteriorated due to her advanced age and she died yesterday
despite the best efforts of doctors.

Another tick-related CCHF case that ended in tragedy happened, this
time in Ankara. A 15-year-old shepherd picked a tick off his dog and
squashed the tick while grazing his sheep in Corum's Sungurlu
district. He did not wash his hands after killing the tick and had a
fever 2 days later, when he was sent to Sungurlu State Hospital. He
was sent to the Ankara Numune Hospital on Monday after being
diagnosed with CCHF and died on Wednesday evening [18 Jun 2008].

Dr. Fikret Purtul, the health director of Corum, a town in Central
Anatolia which has seen most of the CCHF cases in recent years, noted
that awareness campaigns carried out in rural and urban areas about
CCHF have been effective.

"School directors were trained in Corum and fliers have been
distributed. Teams of medical professionals have traveled to villages
to raise awareness about CCHF. We have also distributed anti-tick
repellants, an initiative funded by the Health Ministry, to
villagers. Locals have been advised to visit a hospital if they have
been bitten by a tick. Patients that have contacted hospitals will be
monitored. Once their lab and test results have been reviewed,
treatment will be tailored to them. When necessary, patients will be
transferred to better-equipped hospitals," he added.

Diyarbakir Health Director Namik Kemal Kubat said 10 people are being
quarantined after 4 of them, including a doctor and a janitor, tested
positive for CCHF. Six of them are suspected of carrying the virus.

Assistant Professor Mahmut KoC, the head physician of Ankara Numune
Hospital, said the condition of 3 doctors and a health care worker
who were treated for CCHF was fairly good and that they would be
discharged by Friday. KoC recalled that the 3 doctors and the health
care worker had contracted the disease while treating a bleeding CCHF patient.

******
[2] Vector abundance
Date: Fri 20 Jun 2008
Source: Turkish Daily News online [edited]
<http://www.turkishdailynews.com.tr/arti ... sid=107772>


Tick bites cases expected to increase in summer
-----------------------------------------------
While ticks have become a nightmare in the country, killing more than
26 people in the last 6 months, experts warn that the number of
people infected by ticks may yet increase with rising temperatures in
the coming summer months. The climate conditions affect the spread of
disease, which is activated in hot weather. Population of ticks
carrying the virus multiply faster than usual depending on climate
conditions and high temperatures, Esragul Akinci of the Ankara Numune
Hospital told the Turkish Daily News.

In the last month alone, 7 people in the country have died from
Crimean-Congo hemorrhagic fever, or CCHF, which is transmitted by
tick bites, while hundreds of people have rushed to hospitals after
finding ticks on their skin.

The disease killed 27 people last year [2007]. Among the recent
victims of the disease are 3 doctors from the same hospital who
caught the disease while treating a CCHF patient.

There is no an effective vaccine against the disease, so doctors warn
people to take all possible precaution to protect themselves from
tick bites. The earlier the tick is removed from the skin, the more
effective result is obtained from treatment, said Akinci.

CCHF mainly poses a threat to animals and people living in rural
areas. It is normally transmitted through the bites of infected ticks
or from direct contact with infected blood and tissue from livestock.
The disease has mostly struck farm and slaughterhouse workers in
rural areas of the central Anatolian and Black Sea regions. Experts
recommend that those working in agriculture and with livestock
examine their bodies every day to detect any possible ticks on their
skins. People are encouraged to wear protective clothing when in open
areas, including picnic areas, or while working in the fields. Tick
repellent spray, which can be applied to both the skin and clothing,
is another option suggested by experts.

The Health Ministry has also issued warnings about the danger of
ticks, saying in case of a bite the skin should be covered with the
proper medicine, the tick should be carefully removed with tweezers
and iodine should be applied to the bite. Ticks should never be
killed by hand, according to Health Ministry officials. People bitten
by a tick should be kept under medical observation for 10 days and go
to the nearest hospital if they have symptoms such as fever,
headache, nausea, vomiting or diarrhea. In advanced cases, the
disease is accompanied by a nosebleed and gum bleeding.

Another expert speaking with the daily Cumhuriyet newspaper,
Professor Levent Doianc, said it is believed the disease has existed
in the country for a while, but that improvements in diagnostic
capacity and the disruption of the natural equilibrium have increased
the number of cases, particularly since 2002. Around 1800 cases were
observed in Turkey in the summer months in the last 5 or 6 years. The
figure is likely to increase given the number of people who show only
mild symptoms of the disease and thus do not apply to health
institutions or are improperly diagnosed, according to Doianc. He
said most cases in Turkey are observed between the period of June and
September, with the disease affecting mostly the 3 major river basins
of Kizilirmak, Yesil rmak and Coruh, as well as the provinces of
Samsun, Ordu, Amasya, Corum, Tokat, Yozgat, Erzincan and Trabzon.

The Agriculture Ministry, meanwhile, said it does not find applying
insecticide to the areas where ticks spread practical or useful.
Applying insecticide from air to the areas where the ticks and other
harmful insects are widely seen is not useful as it will harm the
natural equilibrium, said Agriculture Minister Mehdi Eker, speaking
at a conference in Ankara yesterday [19 Jun 2008]. He said the
ministry applied insecticide to areas in 36 provinces where ticks are
widespread and that using the same method in forested areas is not
applicable. The most effective solution, however, is having personal
education on the issue. When you look at the cases so far which have
resulted in death, you will notice that they either failed to apply
the health institutions or applied a wrong treatment. People have to
learn ways to protect themselves against ticks, he said. Experts also
warn that applying insecticide from the air may kill the birds that
destroy ticks, undermining efforts to fight the insects.

Meanwhile, speaking to journalists yesterday, Health Minister Recep
Akda said a specific type of tick causes the disease and that this
breed of the insect survives best in steppe climates and in arid
lands where thickets are common. Farmers and those who deal with
livestock in rural areas constitute the high-risk group, while there
was no such a risk for those living in urban areas, he added. [The
ticks transmitting CCHF are species of the genus _Hyalomma_; see
below. - Mod.CP]

--
Communicated by:
Claudio Po
Servizio Sanita Pubblica
Direzione Generale Sanita e Politiche Sociali
Regione Emilia-Romagna
Viale A. Moro, 21 - 40127 Bologna
Italy

[Ticks are not insects. They are arachnids classified in the
superfamily _Ixodoidea_ that, along with other mites, constitute the
_Acarina_. Ticks are ectoparasites, living by hematophagy on the
blood of mammals, birds, and occasionally reptiles and amphibians.

A map of the provinces of Turkey is available at:
<http://www.mapsofworld.com/turkey/turke ... l-map.html>. - Mod.CP]

KRIM-KONGO-HÄMMORHAGISCHES FIEBER - TÜRKEI ( 09 )
***********************************************
A ProMED-mail post
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ProMED-mail is a program of the
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<http://www.isid.org>

Date: Sun 22 Jun 2008
Source: Today's Zaman online [edited]
<http://www.todayszaman.com/tz-web/detay ... ink=145449>


Since 1st observed in Turkey in 2002, 92 people have died of
Crimean-Congo haemorrhagic fever (CCHF) in the country, including 27
so far this year [2008]. The fever is much more prevalent in the
central Anatolian and eastern Anatolian provinces, especially Tokat,
Corum, Sivas, Amasya, Yozgat and Gumushane. Cases of CCHF are
increasing year by year, a fact that Associate Professor Zati
Vatansever says is due to lack of awareness of the disease in rural
areas, where it is most common.

CCHF seems to be the new threat to the Turkish population. Experts
say the disease, whose victims have increased 5-fold in the last 5
years, will become an even bigger problem in coming years. Seen 6
years ago for the 1st time in Turkey, CCHF has killed 134 people in
the country thus far. Infecting 2 doctors and one other medical staff
member at the Ankara Numune Education and Research Hospital, the
seriousness of disease has reached an alarming point.

CCHF entered world medical literature back in the 1940s. In the
summer of 1944, it was seen in Russian soldiers transporting
agricultural products in Western Crimea for the 1st time. In 1956,
the same disease was witnessed in Congo, which is how the disease got
its name. The history of the disease in Turkey does not go back that
far; CCHF was 1st observed here in the summer of 2002. Esra Demir, in
2002 working as a nurse at the Tokat Social Security Authority (SSK)
Hospital, suddenly felt unwell and was taken to the Ankara Hacettepe
University Hospital. Despite all the attempts to treat her, she died
after one week, and her reason of death was recorded as unknown.
However, 6 more people died in a short period in Tokat, a province in
the Black Sea region, and the deaths were announced as "deaths with
unknown reasons" to the media. The Ministry of Health at first
thought that this unknown disease resembled Q fever, a disease caused
by infection with the bacterium _Coxiella burnetii_. Yet upon finding
that the symptoms were not quite the same as those of Q fever, blood
samples were sent to the laboratories of the Pasteur Institute in
France. The tests conducted there finally confirmed that the disease was CCHF.

Detection of 327 CCHF cases in Tokat province shows that it is one of
the most affected regions in Turkey. Thus, the question arises, why
Tokat? To understand this, we must explore the conditions causing the
disease in the province and the characteristics of infected ticks.
Vatansever, associate professor at the department of parasitology at
the veterinary school of Kafkas University, has been conducting
research on ticks since 1989. And since 2004, when the disease began
to spread, the professor has been analyzing CCHF-infected ticks and
the domestic and wild animals that carry them. There are 850 tick
species in the world, with 32 of them present in Turkey; however, not
all ticks carry the CCHF virus. The virus is carried by ticks of the
[genus] _Hyalomma_. Virus-carrying ticks lodge in small wild animals
such as mice or rabbits and in wild birds. They mature on these
smaller animals and then move on to large wild animals, cattle and
people. After the ticks feed on their host, they detach themselves,
and while male ticks die soon thereafter, females die after laying
their eggs. Stating that the real threat is posed by female ticks,
Vatansever noted: "3 to 5 percent of eggs of a tick bearing the CCHF
virus are also contaminated. In this sense, female ticks present more
of a threat than males." Unless ticks find a suitable host, they live
for an average of one year. In temperatures of 16-18 C, their life
spans can extend up to 3 years. The characteristics of virus-carrying
ticks are different from other ticks. The ticks of the [genus]
_Hyalomma_ are also known as hunters. These ticks burrow into soil,
unlike many other ticks that live on plants. They can feel vibrations
and heat, while also being able to smell and identify carbon dioxide
from exhalation. Vatansever noted that the infected ticks attach
themselves to people who are sitting or lying down, not moving. "They
feel vibrations and sense heat and carbon dioxide emitted from people
and gravitate toward them. They start climbing from a person's feet
and look for an area on which to attach themselves." Ornithologist
Ahmet Kutukcu emphasized another crucial point. He said migratory
birds, particularly storks, play an active role in spreading the
disease. "Yet the real host for the ticks are not birds, but
rodents," he noted.

The number of CCHF virus-transmitting ticks is increasing in the
world, and this is related to an increase in suitable conditions,
which include heat, humidity and proper hosts, Vatansever noted. He
also explained that while only 40 percent of tick species can
reproduce under normal weather conditions, the ecological changes
caused by global warming have led to warmer weather, which prolongs
the life span of ticks and facilitates their reproduction.
Virus-carrying ticks are able to survive in regions where ocean
climates -- typical of the Black Sea region -- and semi-arid climates
-- typical of central Anatolia and eastern Anatolia -- meet, and
those types of ticks prefer areas with small trees and cattle.
Conducting field studies on the range of virus-carrying ticks,
Vatansever found that Corum, Amasya, Tokat, Yozgat, Sivas, Erzurum
and Artvin are at the highest risk. The least hazardous regions are
the Mediterranean and Black Sea coasts, Vatansever said.

Taking a closer look at the deaths caused by ticks reveals that
cattle owners, farmers and shepherds are the most at-risk population.
In addition, soldiers, campers and picnickers, veterinarians, forest
workers and health staff working in infected areas are at risk. The
percentage of deaths among elderly people over 70 is also striking.

Noting that the CCHF-transmitting ticks live on cattle and wild
animals, Vatansever said it is pointless to worry about ticks in
urban areas. However, the professor complained about ignorance in
rural areas. "People in rural [areas] live with ticks from their
childhood to adulthood, and they think they know about ticks. When
they see photographs of ticks in newspapers, they say that the ticks
in the photos do not resemble those living in their villages. They
are exposed to tick bites every summer, but they remove them on their
own. The village people do not want to believe that CCHF-carrying
ticks can be fatal. And then they want to believe the nonsense
alleging that the ticks are sent from Israel. Unfortunately, it is
very hard to do away with these kinds of beliefs," he said, adding
that he believes if rural people had just a little concern over the
ticks, they could take simple measures to protect themselves.

While CCHF virus does not [usually] kill animals, it is often fatal
for people. Symptoms of the infection are sudden fever, nausea,
headache, vomiting and diarrhea. Bleeding of different parts of body
may also accompany these symptoms. Hurrem Bodur, the chief of the
Department of Infectious Diseases at Ankara Numune Hospital,
explained the course of the disease, saying: "There are platelets
circulating in the blood in the human body functioning as bleeding
clotters. But upon entering into the human body via tick bites, the
virus causes the number of platelet cells to decrease, which damages
the veins and which, in turn, causes hemorrhage. External hemorrhage
in parts like the nose and ears or internal hemorrhage, causing parts
of the body to appear bruised and purplish, may occur as a result of
decreasing platelets," Bodur said.

Experts say that disease symptoms appear within one to 3 days or 10
days at most after the virus enters a person's body. It is vital for
a patient to stay in the hospital after infection. Patients who
survive after 2 weeks become permanently immune to the disease.
Raising awareness is of crucial importance to effectively combat the disease.

--
Communicated by:
Claudio Po <ClPo@regione.emilia-romagna.it>

[CCHF is clearly an emerging disease in Turkey, having been
responsible for the deaths of 134 people since its 1st appearance 6
years ago. According to Ministry of Health figures, the death toll
has progressed from 6 in 2002 to 13 in 2004, 13 in 2005, 27 in 2006,
33 in 2007, and 27 so far in 2008. A comprehensive education campaign
needs to be conducted to raise the awareness of the population in rural areas.

The preceding account contains interesting information concerning the
biology of the tick vector, not least the involvement of storks.

A map of the provinces of Turkey is available at:
<http://www.mapsofworld.com/turkey/turke ... l-map.html>.
The most severely affected province of Tokat lies in the centre of
the country. - Mod.CP]

KRIM-KONGO HÄMMORHAGISCHES FIEBER - TÜRKEI (11)
*********************************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 9 Jul 2008
Source: Turkish Daily News, Dogan News Agency report [edited]
<http://www.turkishdailynews.com.tr/arti ... sid=109351>


On Mon 7 Jul 2008, 3 people were pronounced dead at hospitals in the
provinces of Bursa, Canakkale, and Samsun, taking the death toll from
tick bites to 37 in the past 2 months. According to the Dogan news
agency, a resident of the western province of Bursa went camping 10
days ago and was bitten by a tick. He was hospitalised and diagnosed
with the deadly Crimean-Congo hemorrhagic fever (CCHF), and moved to
the intensive care unit.

In the western province of Canakkale, a man died in hospital after
being treated for suspected CCHF infection. He had told relatives
that he had seen a tick on his body. He was buried in a zinc casket
with lime spread over the grave as a precaution. Another person had
died from CCHF in the same province last month [June 2008].

Another man died from CCHF on Monday [7 Jul 2008] in the northern
province of Samsun after he was bitten by a tick and removed it with his hand.

The Health Ministry also issued a statement to warn people against
ticks. In case of a tick bite the skin should be covered with [an
antiseptic]. The tick should be removed by doctors using tweezers
with great care and iodine should be applied to the bite. Health
Ministry officials said ticks should never be killed by hand.

Moreover, those people, touched by any tick, should be kept under
medical observation for 10 days, and go to the nearest hospital if
they have symptoms such as fever, headache, nausea, vomiting, or
diarrhea, officials from the Health Ministry said.

CCHF mainly affects animals. Ticks, which live on sheep and cattle,
can sometimes pass the virus to people. It is a [haemorrhagic] fever
where patients can bleed to death if they are not treated quickly.
Those infected can transmit the virus through their blood or saliva.
The disease is endemic in parts of Africa, Asia, and Europe. Health
authorities said a warmer climate, which Turkey has experienced in
recent years, could mean a larger tick population that could in turn
infect more people with the disease.

--
Communicated by:
ProMED-mail Rapporteur A-Lan Banks

[The CCHF death toll in Turkey has risen from 33 on 4 Jul 2008 , when
more than 550 cases were recorded, to the present 37.

The HealthMap/ProMED-mail interactive map of Turkey is available at
<http://healthmap.org/promed?v=39.1,35.2,5>,
and a map delineating the administrative provinces of Turkey can be accessed at
<http://www.mapsofworld.com/turkey/turke ... l-map.html>. - Mod.CP]

KRIM-KONGO HÄMMORHAGISCHES FIEBER - TÜRKEI (12)
*********************************************
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 10 Jul 2008
Source: Today's Zaman [edited]
<http://www.todayszaman.com/tz-web/detay ... ink=147168>


A woman from the central Anatolian province of Cankiri who contracted
Crimean-Congo hemorrhagic fever (CCHF) died in a hospital in Ankara
on Thursday [10 Jul 2008]. The woman from Cankiri's Orta district,
was bitten by a tick and hospitalized at Cankiri State Hospital. As
her condition worsened, she was transferred to Ankara Numune Hospital
last Sunday [6 Jul 2008]. Doctors diagnosed her symptoms to have been
caused by a fatal viral disease [CCHF] carried by a species of tick.
She was subsequently moved to Diskapi Research Hospital for
treatment, where she died despite medical efforts to save her. She
was buried in her hometown of Kalfat in Orta.

--
Communicated by:
Claudio Po
<clpo@regione.emilia-romagna.it>

[The CCHF death toll in Turkey was reported to be 37 on Mon 7 Jul
2008. The death of this woman presumably raises the death toll to 38.

MILZBRAND, HUMAN - KIRGISISTAN: (JALALABAD, OSH)
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[1]
Date: 11 Jul 2008
Source: IA Gazeta.kz [trans. Corr.ATS, edited]
<http://www.gazeta.kz/art.asp?aid=113971>


The press service of the Republican Ministry of Emergencies reports
that a person died from skin anthrax in the village of Barpi. The
doctors report that the cause of death was progressive cardiac and
circulatory failure.

According to preliminary information, there are 4 people in the same
hospital with anthrax, and one of them died. The conditions of the 3
other patients are rated as mild. Specimens have been taken for
laboratory tests.

Additionally, there are 6 other patients in the city hospital at
Kochkorati. There were 475 contact persons, including 276 children,
around these cases. All are now under medical observation.

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[There are thousands of anthrax burial grounds in the Republic, and
most of them are in the Chuyskiy, Jalalabad and Oshskiy regions. The
exact locations of most of them are unknown. There were 23 human
anthrax cases during the last year (2007), which is 1.3 times higher
than during 2006. - Mod.NP]

******
[2]
Date: 12 Jul 2008
Source: Trend News [edited]
<http://news.trendaz.com/?show=news&newsid=1245631〈=EN>


A total of 4 anthrax disease cases were officially registered in Osh
city on 10 Jul 2008, Jalallidin Gaybulin, the director of the
Republican Quarantine and Specially Dangerous Infection Centre, told
Trend News.

A total of 5 people were hospitalized on suspicion of anthrax in
Suzakski region, and one of these patients, a 78-year-old pensioner
and resident of Barp village council and Achi District, was
hospitalized with a provisional diagnosis of "skin anthrax on the
back surface of the left hand" on 9 Jul 2008. The patient died of
cardiovascular deficiency at 6:30 AM on 10 Jul 2008, despite measures
taken by medical workers. A diagnosis of anthrax is still being confirmed.

At present, anti-epidemic measures taken in regions where anthrax
diseases were registered are under the control of the government.

[Byline: R. Meshedihasanli]

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[These 2 accounts appear to relate to the same circumstances, but the
1st emphasizes cases in the oblast of Jalalabad and the 2nd in Osh.
Logically, there are 2 simultaneous outbreaks involving 4, 5, or 6
persons in the 2 neighboring oblasts. Both oblasts are notorious for
the frequency of livestock and human cases of anthrax, and part of
the problem is the severity of the situation in the enclosed
adjoining region of eastern Uzbekistan and the continuity of the 2
agricultural systems there. In spite of NP's remarks, the locations
of just under half the outbreaks in the past 50 years in Kyrgyzstan
are known and plotted, and a total of 1180 sites are registered; see
20071227.4154. This is thanks to the hard and excellent work of Dr.
Asankadyr Junushov and his staff in Bishkek. In spite of logistical
problems in the country, he has raised the national awareness of
anthrax and thus improved reporting and diagnosis.

For the regions of Kygyzstan and general orientation, go to:
<http://www.fallingrain.com/world/KG/>.
For Kochkorati or Kochkorata go to:
<http://www.fallingrain.com/world/KG/0/KochkorAta.html>.
For Osh, south of Jalalabad Oblast, see:
<http://www.fallingrain.com/world/KG/5/Osh.html>.
- Mod.MHJ]

HAND, FOOT AND MOUTH DISEASE - ASIA (21): MONGOLIA
**************************************************
A ProMED-mail post
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<http://www.isid.org>

Date: Mon 14 Jul 2008
Source: UN Office for the Coordination of Humanitarian Affairs (OCHA),
ReliefWeb, Int Fed of Red Cross and Red Crescent Societies report
[abbreviated and edited]
<http://www.reliefweb.int/rw/rwb.nsf/db9 ... enDocument>


Mongolia: hand-foot-mouth disease update No. 1: 10 Jun-8 Jul 2008
-----------------------------------------------------------------
Summary
-------
Hygiene promotion activities have commenced and already volunteers and
staff of the Mongolian Red Cross Society have been mobilized to deliver
important messages to the public about the prevention of this disease.
Activities to support capacity building at the branches for the ongoing
prevention of hand-foot-mouth disease will start in late July [2008].

The situation
-------------
Since 8 May 2008 a serious outbreak of hand-foot-mouth disease (HFMD) due
to enterovirus 71 (EV71) has affected thousands of children and families
throughout Mongolia. As of 7 Jul 2008, a total of 2618 people have been
diagnosed with this virus. 83 per cent of the reported enteroviral diseases
occurred in children who were younger than 10 years and 10 per cent of
those infected were younger than one year.

Although many have recovered on their own and no fatal cases have been
reported to date, as of 7 Jul 2008, 24.5 per cent of all those diagnosed
with enterovirus 71 had complications that required hospitalizations.
Several patients had severe complications such as aseptic meningitis,
encephalitis, myocarditis, and poliomyelitis-like paralysis, which may lead
to disability or even death. It is known that pulmonary edema or
haemorrhage, which is a common complication, can kill a child within one
day, therefore health workers all over the country have been working
around-the-clock providing intensive care to patients in critical
condition. Largely owing credit to these efforts, no casualties have been
reported to date. As of 7 Jul 2008, 162 individuals remain hospitalized and
599 people have been discharged from hospitals.

Total number of cases of HFMD (8 May-7 Jul 2008)
------------------------------------------------
According to the Ministry of Health of Mongolia this is the largest spread
of enterovirus recorded so far in Mongolia and since the 1st case in 8 May
2008, it has affected 90 per cent of all territories within Mongolia. Next
to Ulaanbaatar, the most affected areas are in the Eastern region
(Sukhbaatar, Khentii, Dornod provinces), the Orkhon-Selenge region (Selenge
province), the Gobi or Southern region (Dornogobi province), and the
Khangai region (Uvurhangai province).

As Naadam, Mongolia's most popular festival [comprising outdoor events such
as equestrianism, wrestling, archery, et alia] approaches, the authorities
fear that it may bring another spike in the epidemic of HFMD, and are thus
conducting activities to increase the communities' outbreak control and
preparedness. While schools and kindergartens resumed their normal
operations in most places, the youth summer camps have been suspended until
mid-July [2008].

Concurrent with this major outbreak, many of the affected provinces are
coping with the devastating consequences of the snow fall disaster that
struck most of Mongolia in early May [2008] in which 52 people died and 150
000 livestock animals perished. It was estimated that 1500 people were
affected in that disaster and now face risk of encountering HFMD shortly
thereafter.

For further information specifically related to this situation please
contact the Mongolian Red Cross Society (Mr Ravdan Samdandobji,
secretary-general) <redcross@magicnet.mn>.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[Since 22 May 2008 the number of cases of HFMD in Mongolia has escalated
from around 1000 to 2618. Remarkably, there have been no fatalities despite
the occurrence of severe weather conditions.

The HealthMap/ProMED-mail interactive map of Mongolia can be accessed at
<http://healthmap.org/promed?v=46.8,103.1,5>, and a map of the provinces of
Mongolia is available at
<http://www.mapsofworld.com/mongolia/mon ... l-map.html>. - Mod.CP]

MILZBRAND, HUMAN - KIRGISISTAN (02): JALALABAD, OSH
************************************************
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<http://www.isid.org>

[1]
Date: 15 Jul 2008
Source: IRIN [edited]
<http://www.alertnet.org/thenews/newsdes ... 569a20.htm>


Nine cases of anthrax in humans have been confirmed in southern Kyrgyzstan,
and some 30 patients are suspected of having contracted the disease.

"As of yesterday [14 Jul 2008], we have 9 confirmed cases of anthrax, and
34 people have been hospitalised with suspected cases. All of the cases are
the cutaneous [skin] form," Jalalidin Gaibulin, head of the National Centre
for Quarantine and Especially Dangerous Infections, told IRIN from the
Kyrgyz capital, Bishkek on 15 Jul 2008. All the cases were registered in
southern Kyrgyzstan, in Jalal-Abad and Osh provinces.

"Confirmed cases are receiving treatment, and suspected cases are
undergoing diagnostic procedures and are under constant surveillance. So
the situation is under control," Gaibulin said.

One of the 9 confirmed cases, a 78 year old man, died on 10 Jul 2008.
"After he and his son slaughtered an infected animal, the man got sick and
had been staying at his place for several days unaware of the seriousness
of his condition. He went to hospital only on 9 Jul 2008, but it was too
late, as the disease had already progressed," Gaibulin said.

Kyrgyzstan's Health Ministry said in a statement on its website
<http://www.med.kg/News/2008/7/11.shtml#809> last week that all cases were
related to the slaughtering of cattle without prior veterinary examination.
The main factor leading to the disease is the natural occurrence of anthrax
in the soil, it said.

"Humans contract anthrax via contact with infected animals or their
carcasses, and the cattle get infected while grazing in places where
infected animals had either died or been buried, or where the anthrax virus
is still in the soil," Gaibulin explained.

There were 23 confirmed cases of anthrax in Kyrgyzstan in 2007, all of them
in the south. No casualties were reported last year [2007], according to
Gaibulin.

Preventing outbreaks not easy: preventing anthrax is complex, involving
health facilities, veterinary bodies, local authorities and communities
themselves, the health official said. "It is a multi-faceted issue, and all
parties involved should act together. For instance, villagers [try] to
minimise their losses whenever their animals fall sick, so what they do is
slaughter them, sell or distribute the meat without proper veterinary
examination, and end up with various animal-borne diseases like anthrax,
brucellosis, etc," Gaibulin said, adding that awareness-raising activities
among the population were needed.

Every year, health workers vaccinate "at risk groups" -- people in contact
with cattle, like herders and butchers -- against various infections,
according to the Health Ministry. Meanwhile, veterinary workers are
currently vaccinating cattle in areas where anthrax cases have been reported.

--
communicated by:
ProMED-mail <promed@promedmail.org>

[Biologically, the prevention of livestock anthrax could not be easier:
Annual vaccination and proper carcass management when cases occur.
Unfortunately, where rural communication is deficient and the veterinary
presence light, the social aspects of disease control take charge, and any
weaknesses result in what we see here in Central Asia. And, as with
previous Kyrgyz outbreaks, they are associated with the slaughter and
butchering of sick cattle. This report confirms what we had suspected
earlier about there being multiple outbreaks in Osh and Jalalabad and firms
up the numbers of people affected. See the following report. The case of
the 78 year old man reinforces the necessary advice that cutaneous anthrax
cases should not be ignored, especially by elderly people, but treated
early and promptly with antibiotics, when a cure is assured. - Mod.MHJ]

******
[2]
Date: 16 Jul 2008
Source: Ferghana.Ru news [trans. & summ. Mod.NP, edited]
<http://www.ferghana.ru/news.php?id=9670>


Summary of 9 cases of anthrax:
- 3 confirmed cases in the Uzlensky district of the Osh region (in May 2008)
- 1 case in the Aravansky district of the Osh region
- 1 in Osh city
- 2 in the Suzaksky district of the Jalalabad region;
- 2 in the Nookensky district of the Jalalabad region
- 34 persons are under medical supervision, 20 in the Nooksky district of
the Jalalabad region, 4 in the Suzaksky district of the Jalalabad region, 6
in the Aravansky district of Osh region and 4 in Osh.

--
communicated by:
ProMED-mail <promed@promedmail.org>

[Thanks to Natalia for finding and summarizing this report. - Mod.MHJ]

MILZBRAND, HUMAN - KIRGISISTAN (03): JALALABAD, OSH
************************************************
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Date: Wed 16 Jul 2008
Source: Kazinform [edited]
<http://www.inform.kz/showarticle3.php?l ... &id=167217>


A total of 6 people have been hospitalized with anthrax in southern
Kyrgyzstan after eating contaminated beef, the country's emergencies
ministry said on Tuesday [15 Jul 2008].

A total of 167 people are known to have eaten the infected beef, and 6
cases of infection with the lethal disease have been confirmed in the
Central Asian country's Osh Region. The condition of the other 161 is being
monitored.

Vets have decontaminated the site where an infected cow was put down and
incinerated.

The outbreak is the 2nd in about a month in southern Kyrgyzstan. In early
June [2008], 7 people were hospitalized with anthrax in the neighboring
Jalalabad region, of whom one died.

A total of 475 people who have come into contact with infected cattle are
undergoing preventive treatment.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[This report -- delayed just in case there were any further updates from
Bishkek -- gives us an attack rate for eating contaminated beef in Osh of
6/167 or 3.6 per cent, which may explain why people put themselves at such
risk. Of course if there is a communal habit of eating such meat we can
expect that the community immunity has been increased by repeated past
exposures, which will feed this habit. - Mod.MHJ]

MILZBRAND HUMAN - KIRGISISTAN (04): JALALABAD, OSH
************************************************
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International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 21 Jul 2008
From: Asankadyr Junushov <junushov@mail.ru>


[Re: Anthrax, human - Kyrgyzstan (02): Jalalabad, Osh 20080716.2161]
Anthrax - Kyrgyzstan: epidemiological situation as of 17 Jul 2008
--------------------------------------------------------------------
37 people have been hospitalized:
Osh Oblast: Aravan region -- 6 people; Osh region -- 4 people;
Jalalabad Oblast: Suzak region -- 4 people; Nooken region -- 23 people.

The diagnosis of "anthrax" has been confirmed by laboratory for 11
people. All the patients had the skin type of anthrax. All the
patients were involved in the slaughter of sick livestock, meat
cutting, and washing of the [internal viscera].

One fatal case was registered in the village of Achy, Barpy Rural
Council, Suzak [district]. The [78-year-old] dead person, was
involved in the cutting of meat from his dead cow.

In Jalalabad oblast the outbreak took place in the following areas:
Kyrgo, Mombekovo Rural Council, Nooken district
Zhazgak Mombekovo Rural Council, Nooken district
Achy, Barpy Rural Council, Suzak district.

--
Dr Asankadyr Junushov
Director
Biotechnology Institute
National Academy of Sciences of Kyrgyzstan
Bishkek, Kyrgyzstan
<junushov@mail.ru>

[This is an increase of 2 laboratory confirmations, a doubling of the
cases in Osh from 5 to 10, and a significant increase in the clinical
cases reported for Nooken.

As ever our thanks to Asankadyr for this authoritative update. - Mod.MHJ]

MILZBRAND, HUMAN, BOVINE - GEORGIEN (WESTERN)
******************************************
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<http://www.isid.org>

Date: 23 Jul 2008
Source: IA "Regnum" [translated by Mod.NP, edited]
http://www.regnum.ru/news/1031444.html



4th case of anthrax has been recorded in the West Georgia
---------------------------------------------------------
The severe form of anthrax was found in Rodinaury village, Zestafonsky
district; 2 persons were admitted to the Infectious Diseases
Department of the hospital in Zestafony several days ago when their
health condition sharply became worse. The patients received treatment
in time and now their lives are safe.

The source of the infection was sick cattle. This is the 4th case of
anthrax in west Georgia during the last month. All patients are alive.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[According to the National centre of disease control and medical
statistics of Georgia, 18 cases of anthrax have been recorded already
this year (2008). Last year [2007] 42 cases were reported; see:
<http://www.day.az/news/georgia/125324.html>.

The population of Georgia is about 4.5 million inhabitants. This
amount of anthrax cases shows a high level of morbidity for such small
country - Mod.NP]

[The news report is a mite confused as it has a headline on the 4th
case and then refers to 2 people being hospitalised, presumably the
3rd and 4th individuals to be diagnosed. Georgia rarely reports more
than 6 bovine outbreaks in any one year, and only a smattering of
outbreaks in sheep, goats and horses, but it has widespread human
cases throughout the country: 51 (1999), 29 (2000), 26 (2001), 15
(2002), 27 (2003), 45 (2004), 19 (2005), 38 (2006), & 42 (2007). This
reflects a general failure of veterinary public health, government
veterinary services, and of public health. - Mod.MHJ]

[A map of Georgia is available at:
<http://www.un.org/Depts/Cartographic/ma ... eorgia.pdf>. - CopyEd.EJP]

UNDIAGNOSED DEATHS - INDIA: ORISSA, REQUEST FOR INFORMATION
***************************************
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Date: 2 Aug 2008
Source: The Hindu [edited]
<http://www.hindu.com/holnus/004200808021541.htm>


At least 10 persons have died of a mysterious disease within a span
of 8 days near Bondamunda, about 10 km from here, triggering panic
among local people.

15 other patients from the area who complained of mild fever, severe
headache and vomiting are being treated in several hospitals of the
district, doctors said, adding that efforts are on to identify the
disease.

The mystery disease had claimed 6 lives last week, while 4 people
died yesterday [1 Aug 2008] in the Tilikanagar slum area near here.

Assistant District Medical Officer R N Das told PTI that a team of
doctors was rushed to the affected area this morning [2 Aug 2008]
with medicines.

Residents of the slum area accused the Rourkela Municipality of
ignoring the locals.

--
Communicated by:
HealthMap alerts via
ProMED-mail <promed@promedmail.org>

[The symptom complex of "mild fever, severe headache, and vomiting"
is significantly broad and vague that narrowing down a differential
diagnosis list is a challenge. Fever, headache and vomiting can be
related to a neurologic infection such as Japanese encephalitis or
henipavirus; it can be related to a gastrointestinal infection (such
as cholera, although the presence of fever is unusual); it can be
related to a systemic infection such as malaria or leptospirosis, all
of which are possible diagnoses in Orissa India.

ProMED-mail would greatly appreciate receiving more information on
these as yet undiagnosed deaths from knowledgeable sources in the
region.

For a map of India with states, see
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>.
Orissa is located in the central eastern part of India just south of
West Bengal (which borders Bangladesh) and Jharkhand and east of
Chhattisbarh states. Rourkela is located in the extreme northwest of
Orissa, near the border with Jharkhand and Chhattisgarh states.

For the interactive HealthMap/ProMED map of India with links to
additional recent postings on outbreaks in India and nearby
countries, see
<http://healthmap.org/promed?v=22.9,79.6,5>.
- Mod.MPP]
................................................mpp/msp/lm

POLIOMYELITIS(05): AFGHANISTAN, INDIA, PAKISTAN
************************************************
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<http://www.promedmail.org>
ProMED-mail is a program of the
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<http://www.isid.org>

In this update:
[1] Pakistan
[2] Afghanistan
[3] India

******
[1] Pakistan
Date: Sun 3 Aug 2008
Source: Online-International News Network (Pakistan) [edited]
<http://www.onlinenews.com.pk/details.php?id=131459>


Eight new polio cases reported in Pakistan, WHO puts pressure on EPI
--------------------------------------------------------------------
The Ministry of Health is facing pressure from international donor
organizations, especially from UNICEF [United Nations Children's
Fund] and the World Heath Organization [WHO], after [a rapid]
increase in polio cases in Pakistan.

According to resources at the Ministry of Health, the Expanded
Programme on Immunization (EPI) is under a great [pressure from]
UNICEF and WHO as 8 new cases were found in a week in Pakistan.

EPI has got the services of the Lady Health Workers [programme] to
run the polio campaign effectively; for this purpose EPI is starting
a 2-day training workshop today [Mon 4 Aug 2008] at a local hotel in
which co-coordinators from district and tehsil [local administrative
division] levels from 44 selected districts will participate. Later
on they will train the other Lady Health Workers in their respective districts.

The most polio cases among the 8 have P1 poliovirus [type 1 wild
poliovirus -- WPV1], which could be epidemic any time and according
to (WHO) P1 could affect 312 children of its surrounding areas.

So far, 23 polio cases have been detected this year [2008] while the
number of cases in previous year was 33.

Meanwhile it could be a great worry if the number of cases increases
from 33 this year [2008].

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[According to the polio eradication website, as of 29 Jul 2008 there
have been 17 cases of polio confirmed to date in 2008, as compared
with 11 cases confirmed during the same period in 2007 -- a 55
percent increase in reported cases from the previous year (see
<http://www.polioeradication.org/casecount.asp>).

"- One new case was reported in the past week (WPV1 from Swat
district in the North West Frontier Province -- NWFP), bringing the
total number of cases for 2008 to 17. The most recent case had onset
of paralysis on 3 Jul 2008 (WPV1 from NWFP).
- This latest case from Swat follows confirmation of an initial WPV1
case reported from the district last week [21-27 Jul 2008], which had
been the 1st polio case in Swat since June 2007. Both WPV1s were
isolated from children who had never been immunized. Access remains
significantly compromised in this area due to insecurity.
- 2 mop-up campaigns are to be held in response, the 1st as part of
larger subnational immunization days (SNIDs) currently underway, and
the 2nd on 5 Aug 2008 aiming to vaccinate 800 000 children in the
area. Discussions are underway between the District Health
Administration and tribal leadership to ensure increased access to
populations during these immunization campaigns.
-* At the same time, the Federal Ministry of Health convened an
emergency meeting of the NWFP and Federally Administered Tribal Areas
(FATA) health authorities. Discussions focused on the strong
opportunity to eradicate polio and the need to continue the fight
against the disease, drawing on the experience from other polio-free
countries, which had faced similar challenges, such as Somalia. The
meeting discussed ways to ensure access to each and every child by
involving all stakeholders, especially in security-compromised areas of NWFP.
- SNIDs are currently underway (28-30 Jul 2008) using mOPV1
[monovalent oral polio vaccine-1], in all of Sindh, as well as
high-risk areas of Balochistan, NWFP, and Punjab."

Unfortunately vaccination activities in parts of Pakistan have been
significantly influenced (negatively) by civil unrest, as has been
the case in Afghanistan discussed below in part [2] of this update.

For a map of Pakistan with provinces, see
<http://www.lib.utexas.edu/maps/middle_e ... l_2002.jpg>.
NWFP (North West Frontier Province) and the FATA (Federally
Administrated Tribal Areas) border with Afghanistan and have been
significantly impacted and involved with the ongoing civil unrest in
Afghanistan.

For the interactive HealthMap/ProMED map of Pakistan with links to
recent postings of other outbreaks in Pakistan and surrounding
countries, see <http://healthmap.org/promed?v=30,69.4,5>. - Mod.MPP]

******
[2] Afghanistan
Date: Sun 3 Aug 2008
Source: Agence France-Presse (AFP) [edited]
<http://afp.google.com/article/ALeqM5jDi ... B1ZHfU5v3A>


Thirteen Afghan polio cases, unrest hampering vaccinations
----------------------------------------------------------
Afghanistan has this year [2008] recorded 13 new cases of polio,
which is only endemic in 3 other countries worldwide, the health
minister said Saturday [2 Aug 2008].

Almost all the new cases were in the southern provinces, which see
the worst of a deadly Taliban rebel-linked insurgency, with the
insecurity hampering efforts to wipe out the crippling disease.

"We have 13 cases since the beginning of this year [2008]," health
minister Mohammad Amin Fatimie told an event to mark the start of a
new round of polio vaccinations.

Most of the cases were in children aged [less than] 2 years, he said.
The number was down from 31 in 2006 and 17 in 2007.

"The 1st challenge is that the immunisation teams are not able to
cover every single house and the enemies of Afghanistan are stopping
the process," Fatimie said, referring to Taliban and other militants.

There are large parts of mainly southern Afghanistan that are
considered dangerous, even for Afghans, with insurgents and other
rebels kidnapping and sometimes killing people associated with the government.

According to an umbrella body of NGOs, the Agency Coordinating Body
for Afghan Relief, 19 non-government organisation workers have been
killed this year [2008]

In some cases Taliban were speaking out against the vaccination
campaign and telling people not to participate, the health minister said.

"The 2nd challenge is that one of the 4 countries that have polio is
a neighbouring country, Pakistan," he said.

Hundreds of people move every day between Afghanistan and Pakistan,
where there have been 20 cases of polio this year [2008], and this
spreads infection.

"Our coverage is 90 percent in insecure areas and in the areas where
there is active fighting, or the area is battlefield, or there is
danger from mines -- they are necessarily out of coverage," ministry
spokesman Abdullah Fahim said. [this paragraph seems to suggest that
in areas with active fighting or where there had been active fighting
and it is known that land mines had been placed, the coverages with
vaccines are suboptimal, whereas other areas in the insecure zone
have reported 90 percent coverage with the vaccines. - Mod.MPP]

The ministry said the 3-day immunisation drive starting Sunday [3 Aug
2008] would see more than 52 000 staff and volunteers deliver oral
polio vaccinations to 7.5 million children across the country.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[According to the most recent information available on the polio
eradication website (dated 29 Jul 2008) as of 29 Jul 2008 there have
been 17 cases of polio confirmed whereas in the same timeframe in
2007 there had been 5 cases of polio confirmed (see
<http://www.polioeradication.org/casecount.asp>):

"- 2 new cases were reported in the past week (both WPV1s [wild
poliovirus type 1]), bringing the total number of cases for 2008 to
13. The most recent case had onset of paralysis on 3 Jul 2008 (WPV1
from Kandahar).
- One of the newly reported cases is from Uruzgan province, in the
Southern Region. It follows confirmation of an initial WPV1 case
reported from this province last week [21-27 Jul 2008], which had
been the 1st polio case reported from Uruzgan since September 2006.
Both WPV1s were isolated from children who had never been immunized.
Access remains significantly compromised in this area due to insecurity.
- Uruzgan will be covered as part of the upcoming National
Immunization Days (NIDs), to be held on 3-5 Aug 2008 (with trivalent OPV)."

The newswire above probably reflects the increase in press coverage
leading up to the National Immunization Days in an attempt to
heighten awareness of the population to the situation with polio in
the country and the need for vaccinations. Unfortunately as both the
newswire and the summary above from the polio eradication website
point out, civil unrest has impeded vaccination activities in the
affected area of the country.

For a map of Afghanistan, see
<http://www.lib.utexas.edu/maps/middle_e ... l_2003.jpg>.
Uruzgan province (Oruzgan on the map) is immediately north of
Kandahar province, which borders with Pakistan to the south.

For the interactive HealthMap/ProMED map of Afghanistan with links to
other recent postings on outbreaks in Afghanistan and surrounding
countries, see <http://healthmap.org/promed?v=33.8,66,5>. - Mod.MPP]

******
[3] India
Date: Sun 3 Aug 2008
Source: The Telegraph (Calcutta) [edited]
<http://www.telegraphindia.com/1080803/j ... 640305.jsp>


Debut of type 3 polio dose
--------------------------
The vaccine to treat type 3 polio, many cases of which have been
detected in the country recently, will be used in the state for the
1st time tomorrow [4 Aug 2008].

A type 3 polio case was detected in Howrah's Panchla earlier this
year [2008]. Before that, the type [wild poliovirus type 3] was
detected in 2003.

In 2007, of the 874 cases of polio detected across the country, 794
were type 3. Of the 336 cases this year [2008], 346 were type 3. Of
these, 209 cases were from Bihar.

Considering Bengal's proximity with Bihar and that many migrants come
[to Bihar], experts saw the possibility of the type 3 virus spreading
fast. "We will have the 1st pulse polio round with the monovalent
oral vaccine of type 3 tomorrow [4 Aug 2008] as there is a case in
Howrah and also keeping in mind demographic factors," said state
health commissioner Asim Das.

Studies say the monovalent type 3 vaccine gives greater immunity --
almost 5 times more -- to type 3 cases than the trivalent vaccine.

[Byline: Jayanta Basu]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[According to the most recent polio eradication website update on
polio in India (as of 29 Jul 2008), there have been 331 cases of
polio confirmed to date for 2008 (see
<http://www.polioeradication.org/casecount.asp>.

"- 15 new cases were reported in the past week (one WPV1 from Badaun,
Utttar Pradesh; and 14 WPV3s [wild poliovirus type 3] from Bihar and
Uttar Pradesh), bringing the total number of cases for 2008 to 331.
The most recent case had onset of paralysis on 11 Jul 2008 (WPV3 from
Uttar Pradesh).
- The reporting of a 2nd WPV1 case from Badaun following confirmation
of an initial WPV1 from May [2008] -- both genetically linked to
ongoing WPV1 transmission in access-compromised areas of central
Bihar state -- underscores the risk this particular serotype
continues to pose to children across India.
- A programmatic review of supplementary immunization activity (SIA)
operations in Badaun suggests that the overall quality of activities
being conducted in this district in 2008 has declined. The risk of
further spread of WPV1 in this area of western Uttar Pradesh is
therefore deemed as high, particularly with the onset of the high
season (rainy season) for polio transmission.
- Western Uttar Pradesh had previously been free of WPV1 for more
than 12 months. Efforts must be maximized to prevent the further
spread to other areas within western Uttar Pradesh (such as Moradabad
district).
- In Bihar, specific strategies to reach all populations in
access-compromised areas -- notably the Kosi river basin in the
central part of the state -- continue to be implemented, as part of
urgent efforts to rapidly interrupt the remaining low-level
indigenous WPV1 transmission.
- The strategic use of monovalent OPV type 3 (mOPV3) is continuing in
both Bihar and Uttar Pradesh, with the result that the WPV3 outbreaks
in both states have been significantly controlled.
- The next SIAs are: a mop-up in western Uttar Pradesh (currently
underway, launched on 27 Jul 2008) with monovalent OPV type 1
(mOPV1); and, a mop-up in Bihar and Assam on 10 Aug 2008, using mOPV1
(to be confirmed by the Government of India)."

There was an 11-month-old infant with confirmed WPV3 associated polio
in late June 2008 (see
<http://www.expressindia.com/latest-news ... ah/326025/>
for more details.

As mentioned by this moderator in an earlier posting on polio in
India, "As a reminder, in recent years, the polio eradication effort
has switched to the use of monovalent oral poliovirus vaccine (mOPV)
using the vaccine virus type 1 to interrupt transmission of the then
predominant WPV1 circulation in the country. The resurgence of WPV3
as a predominant type in circulation serves to validate that the
widespread use of mOPV1 was successful in interrupting transmission
of WPV1 in most of the country. The clear challenge ahead will be the
interruption of WPV3 circulation without jeopardizing the
interruption of WPV1 circulation." (see ProMED-mail Poliomyelitis:
India 20080303.0876).

For a map of India with states, see
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>

Howrah district is located in West Bengal state. For a map of
districts in West Bengal state, see
<http://en.wikipedia.org/wiki/Image:West ... mbered.svg>.

For the interactive HealthMap/ProMED map of India with links to
additional recent postings on outbreaks in India and nearby countries, see
<http://healthmap.org/promed?v=22.9,79.6,5>.

The updates above contain information on 3 out of the 4 remaining
endemic countries for polio -- Afghanistan, Pakistan, and India. The
4th remaining endemic country is Nigeria (see prior ProMED-mail
postings listed below). While the newswires are all oriented towards
announcing immunization activities in the countries, they serve as
good reminders that the WPV is still circulating in this region of
Asia, with increases in reported cases in 2008 to date when compared
to 2007 (166 percent more cases reported in 2008).

Indien - Malaria
04.08.2008

Aus mehreren Regionen werden auf Grund der anhaltenden Monsunsaison erhöhte Malariafallzahlen gemeldet. Unter anderem aus den Bundesstaaten Tripura (NO), Andra Pradesh (S), Manipur (NE) und Haryana (N) sowie aus Mumbai (Bombay) (W). Schutz vor nachtaktiven Stechmücken beachten. / Quelle: crm
_____________________

Indien - Darminfektionen
04.08.2008

Risiko für Durchfallerkrankungen landesweit, vor allem in den nach starken Monsunregen überschwemmten Gebieten von Bihar und West Bengal. Mit Cholera ist regional oder örtlich zu rechnen, aktuell kleinere Ausbrüche in Delhi und Haryana. Hepatitis A, E, Typhus, Paratyphus, Milzbrand, die auf gleichem Wege übertragen werden können, sind in Indien weit verbreitet. Trotz wiederholter Impfkampagnen sind die Fallzahlen für Polio seit vorigem Jahr wieder angestiegen, die meisten stammen aus Uttar Pradesh und Bihar (N). Insgesamt 864 Erkrankungen wurden 2007 gemeldet, bis Juni d.J. sind es bereits wieder 287 Fälle. Hygiene und Impfschutz beachten. / Quelle: crm